Please join us for 3 fun filled days featuring stories from the adored children's book author, Laura Numeroff! Your child will enjoy an exciting morning filled with stories, crafts, games, songs, snacks and more! May 29, 30, 31/ 8:30-11:30am. Cost $85 This camp is for children ages 3-5 (*all campers must be fully potty trained).

* Required

Student Information

Name of Child: *

Your answer

Current Age of Child (all children must be fully potty trained) *

3 years old

4 years old

5 years old

Grade/Class Entering 2018-2019 School Year *

Preschool 3's

Pre-Kindergarten 4's

Kindergarten

Date of Birth: *

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DD

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YYYY

Please list any allergies or known medical conditions of which LCA should be aware. *

Your answer

Parent Information/Emergency Contact

Parent/Guardian Name (First and Last) *

Your answer

Parent Primary Email *

Your answer

Parent Phone Number (primary contact number) *

Your answer

Emergency Contact Name (please list the name of someone other than the parent who may be contacted in the event of an emergency): *

Your answer

Emergency Contact Phone Number: *

Your answer

Primary Pick-up

Your child will only be released to a parent and/or the other adult listed on this form. Any changes must be communicated in writing prior to pick-up that day. Please list below the name of the person who will be picking your child up from camp each day. Also, please indicate the relationship of the person to the child.

Please list the name of the person(s) who will be picking your child up from camp. Also list the relationship to the child (ie. parent, grandparent, neighbor) *

Your answer

Medical Release

I parent/guardian of the above named child(ren), hereby release Landenberg Christian Academy agents and/or affiliates, of any responsibility of accident or injury that may occur to my child during Preschool Spring Camp. In the event of an emergency, I authorize my child(ren) named above to receive proper treatment and/or hospitalization after a reasonable attempt is made to contact the parent/legal guardian and/or emergency contact.